الفهرس 
VENTILATOR-ASSOCIATED PNEUMONIA
Disadvantages of inhaled antibioticsOnly 14 pages are availabe for public view
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Abstract
Ventilator-associated pneumonia (VAP) is nosocomial
infection that develops following at least 48 hours of
mechanical ventilation. It can be divided into the following
two categories based on duration of mechanical ventilation:
early onset VAP (occurring on days 2-4) and late onset VAP
(occurring on days ≥5). A third category is based on the risk of
VAP being caused by multidrug resistant pathogens, but
occurring on days 2-4.
The main risk factor for ventilator associated
pneumonia is the presence of the ETT, as it impairs natural
defense mechanisms such as cough reflex and mucociliary
clearance, and allows for direct communication between
the oral-supraglottic space and the lower respiratory tract.
Ventilator associated pneumonia can be prevented by
reduce duration of mechanical ventilation, body positioning
either in semisetting or lateral position, tube modification,
airway care and kinetic therapy.
With the development of MDR gram negative
infections such as Acinetobacter baumannii and Pseudomonas
aeruginosa, the use of aerosolized antimicrobials in the ICU
has been restudied.
Aerosolized antibiotics kill large numbers of bacteria
in the tracheobronchial tree and reducing the bacterial load at the source of infection without the need for high serum
levels.
The main side effects of neblized antibiotics are local
irritanat effects, systemic side effects, lack of legal concern,
cost and emergence of resistant strains.
The aim of the work was to asses efficacy and safety of
nebulized ceftazidime and amikacin in treatment of ventilator
associated pneumonia as adjunctive to intravenous systemic
antibiotics in EL-abbasia chest hospital ICU in six months
from january 2014 till july 2014.
All patients were subjected to full history talking,
full clinical examination (general and local), laboratory
investigations, chest xray and sputum culture by tracheal
aspirate through endotracheal tube.
This study included 36 patients categorized into two
groups:
Case group: Seven Patients received nebulized
ceftazidime (15mg/kg/3h) and eleven patients received
nebulized amikacin (25mg/kg/d) as adjunctive to
systemic antibiotics, (No=18).
Control group: eighteen Patients received systemic
antibiotics only according to sputum culture and
sensitivity, (No=18). Our results showed no significant difference between
aerosolized and control groups as regard to age and sex,
FIO2, pao2 but TLC siginificantly decreased in aerosolized
group than control group and TEMPERATURE
significantly decreased in aerosolized and control groups.
Days of mechanical ventilation and days of ICU stay
were significantly shorter in aerosolized group than control
group.
Mortality was non-significantly less frequent in case
group than control group; Survival was non-significantly
more frequent in control group case than group.